James Reilly (Dublin North, Fine Gael)

I move amendment No. 4:

To delete all words after "Dáil Éireann" and substitute the following:

"— welcomes the decision of the Minister for Health, James Reilly T.D., to establish a Special Delivery Unit in his Department, which has already commenced working intensively to reduce unacceptable waiting times in accident and emergency departments, and for access inpatient, day case and outpatient care;

— supports the Government's policy of developing the role of smaller hospitals to their full potential rather than closing or downgrading them;

— welcomes the Minister's intention to publish a framework for smaller hospitals which will include plans to transfer appropriate services from larger hospitals to smaller facilities, thereby delivering safe care closer to local communities and freeing up capacity in the larger hospitals;

— supports the process of local consultation that will help inform future decisions on the organisation of acute hospital services;

-- notes that the number of inpatient beds is no longer the best indicator of capacity to meet patients' needs, and that the majority of patients treated in hospitals are now day cases or outpatients;

— welcomes the initiatives being taken by the National Ambulance Service to improve pre-hospital emergency services, both in the Cork region and nationally;

— supports the Government's policy on implementation of the mental health strategy, A Vision for Change, through the provision of a range of community based patient-centred modern quality mental health services for the Carlow/Kilkenny/South Tipperary area;

— notes that it is not realistic to exempt the health sector from public expenditure, and associated public service employment, consolidation measures required to restore Ireland's economic sovereignty;

— welcomes the co-operation and flexibility shown to date by health service staff which has ensured that, within the staffing and financial resources available, the health service has increased overall outputs and has continued to meet the health care needs of the population in an appropriate and sustainable manner; and

—supports the need for fundamental reforms of the health service in order to mitigate the impact on services of the required fiscal consolidation measures, including the implementation of universal primary care and the introduction of universal health insurance which will remove two-tier health care and greatly improve access to services for all citizens on an equitable basis."

Regarding comments made by Deputies Varadkar and Burton, Deputy Joe Higgins asked what happened in the last 12 months. The IMF came to town and we lost our economic sovereignty. If that does not make sense to Deputy Higgins, perhaps he will have a look again.

Deputy Boyd Barrett is now in competition with Deputy Higgins for hyperbole. He talks about massacre and slaughter. I ask him to look at the figures for Tallaght Hospital. He mentioned all the other figures. Two weeks ago four people were lying on trolleys in Tallaght Hospital. At one stage last week, no one was lying on a trolley there. Today's figures are as follows. This morning 13 people were on trolleys, 11 of whom were there for less than six hours and two of whom were there for between six and 12 hours. At 2 p.m., according to INMO figures, there were five people on trolleys. It is not all doom and gloom. I admit it is not great, but it is not all doom and gloom.

My primary concern as Minister for Health is for the safety of patients. I cannot stand over unsafe services and I will not stand over a return to untenable, unsustainable and irresponsible service provision. I am working tirelessly with my Government colleagues to make sure every service we deliver is of the highest quality for the patients who need it.

Changes in acute hospital services for vulnerable patients always give rise to public concern. This concern is understandable. Nobody wants to feel that their service is being taken away and no one wants to see what they think is a downgrading of their service.

However, we are not doing any of these things. What we are doing is seeking what is best for patients, and then how best to achieve it. My interest is in how we improve the services we provide to patients and how to achieve this as quickly as possible. The Opposition would like to have people believe that this is a system in chaos. That is not the case. Change is always difficult but change is necessary and we must not step back from that imperative. There is nothing clearer. The Government is working to clear policies aimed at delivering coherent changes to provide better structured and better managed, safer care in a very difficult budgetary situation.

As Minister for Health, I want to guarantee equal access to health care for all in our country. It is my view that this can only be achieved through a single-tier system, supported by universal health insurance, which ensures access based on need, not income. There are a number of important stepping stones along the way. These include hospital reform, including the work of the special delivery unit on waiting times and "money follows the patient" funding, with hospitals established as independent trusts. Work is already under way in this area.

Primary care reform is another key step. The Minister of State, Deputy Shortall, will address that issue in a few moments. We will improve and expand the capacity in the sector on a phased basis to allow for gathering of staff and other resources. This will allow us to move from the old hospital-centred model, with its episodic, reactive and fragmented health care, and to deliver a more proactive, joined-up approach.

Once the building blocks are in place, we will be ready to proceed with the introduction of universal health insurance. This system will give patients a choice of health insurer and will guarantee that everyone has equal access to a comprehensive range of curative services, both primary and hospital care.

The reform programme is a significant undertaking and should not be underestimated. With the scope and complex nature of what is planned in mind, the Government has approved an implementation group on universal health insurance. This group will assist in developing detailed and costed implementation proposals and will also help to push the implementation of the reform programme.

The national clinical care programmes under Dr. Barry White, HSE director of clinical strategy and programmes, mark a very significant development for the health services. The clinical programmes have three main objectives: to improve the quality of care delivered to all users of public health services, to improve access to all services and to improve cost effectiveness.

The multidisciplinary, clinician-led approach of the clinical programmes is a particular strength. Clinical disciplines can work together and share innovative solutions for greater patient benefits. Great credit is due to those involved. The work in the programmes also shows that there can be an appropriate expanded role for smaller hospitals and for greatly increased community-based treatment.

One of my biggest concerns is about our emergency services. It is totally unacceptable that patients have to wait hours and sometimes days to be assessed and treated at an emergency department or to be admitted to hospital. I am also dissatisfied with waiting times for some inpatient and day procedures, and with the time some patients wait for outpatient appointments. Long waiting times and bed access cannot be resolved within emergency departments or hospitals alone. Emergency department difficulties must be addressed on a system-wide basis. No part of this health service operates in isolation.

Earlier this year, I established the special delivery unit in my Department. The unit's role will be to unblock obstacles that stop patients being seen and treated quickly. I have asked the unit to concentrate on a number of priority areas. In emergency departments, for example, admission waiting times are currently unacceptable. People waiting in emergency departments are the most ill and must take the highest priority. Inpatient waiting times have been rising. We are also focusing on this areas. The time from GP referral to an appointment with a consultant is unacceptably long in many specialties. We do not even have accurate figures. However, we are working on this and should have a full handle on it by April of next year. Access time to diagnostics is also too long in many instances.

The special delivery unit is already working on the emergency department issues, visiting emergency departments and examining the data. It has identified 15 hospitals providing unscheduled care that require support. Eight of these require very high support and the HSE has been asked for action plans to address this. The unit will review these plans and will work closely with the hospitals to ensure that long waits on trolleys will be a thing of the past. This week, we will see initiatives taken in the hospitals that are most in need of support, such as Beaumont, Drogheda, Cork, Galway and a number of others.

The special delivery unit initiatives are designed to support medical and nursing staff in the important job they do. Similarly we must support management, and the recent initiatives in Galway and Limerick are to do this.

Smaller hospitals are to be a key part of an integrated hospital service. They will provide a range of services safely, efficiently and as close possible to patients' homes. Smaller hospitals should be the cornerstone of local provision, with clear links to other services. They should provide a range of diagnostics and expanded elective day surgery and medical procedures. These need to transfer from the larger hospitals, freeing these facilities for more complex work. I have no doubt that when this comes to pass and the pressure comes on the larger hospitals to let this work go to smaller hospitals we shall see more protests from various interest groups and possibly from some of the Deputies sitting opposite.

See this speech in context